Medicare and Cataracts Surgery
Cataracts are the leading cause of blindness in the world, according to the World Health Organization. Even though they can occur at any age, cataracts are most common later in life--so common that they're considered part of the aging process. If you have Medicare, it’s a good idea to understand what cataracts are, as well as their symptoms and treatments.
The information contained in this article is for informational purposes only. It should never be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition.
What are cataracts?
Cataracts are a clouding in your eyes' natural lenses. Once cataracts form, the lens becomes increasingly opaque as cataracts interfere with light getting through to your retina. You can have cataracts in one eye or both.
Outpatient cataract surgery is typically covered under Medicare Part B benefits, while inpatient surgery is usually covered under Medicare Part A. You may have greater coverage and lower out-of-pocket costs if you have a Medicare Advantage or Medigap plan.
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The actual cause of cataracts is unknown. However, the breakdown of lens proteins and other chemical changes associated with aging are contributing factors to cataracts.
Symptoms of cataracts
With cataracts, your perception of colors, headlights, and sunlight may change. Double vision can occur in people with cataracts, if the cataracts cause a difference in the degree of opacity in one part of the lens over another. While none of these symptoms automatically mean you have cataracts, they are commonly associated with cataracts.
Types of cataracts
Multiple cataracts: affecting more than one part of the eye
Nuclear cataracts: occurring in the central part of the eye
Cortical cataracts: affecting the cortex, which surrounds the center of the eye
Posterior subcapsular cataracts: occurring at the back of the lens
Treating cataracts with surgery
Doctors will often recommend surgery to treat cataracts. If you have cataracts in both eyes, the surgery is usually performed on one eye at a time. However, the correction of cataracts in one eye may be enough to improve your vision, and your doctor and you may decide to opt to cancel the surgery on your second eye.
Cataracts surgery is usually done on an outpatient basis, and it essentially involves replacing the natural lens in the affected eye with an artificial lens. The surgery has become fairly common: many people have cataracts removed every year, and most surgeries are successful and free of complications. But you should always discuss the risks of such surgeries with your medical provider.
Cataract surgery is extremely popular because it usually provides a lasting solution to a common problem. The surgery removes the entire lens and replaces it with an artificial lens that cannot develop a new cataract.
Your vision will likely continue to improve in the weeks following your cataracts surgery. In some cases, people still require reading glasses even after the cataracts are removed, which will be determined by your eye doctor.
In certain cases, even if you have cataracts, you may not need surgery at all. Ask your doctor about other options to treat cataracts. Medicare may cover non-surgical medical treatments for cataracts depending on necessity and type.
Medicare and cataract surgery
Surgery to correct cataracts is usually performed in people over age 65, and this includes Medicare beneficiaries. That's why it's important to know how Medicare covers the treatment of cataracts.
Surgery to remove cataracts is covered by Medicare, but Medicare only pays expenses directly related to the cataracts. If you had a non Medicare-covered condition before developing cataracts, you may be able to treat that condition during the same surgery, but Medicare only covers the costs associated with cataracts. Medicare will ask the surgeon to bill you separately for the parts not related to the cataracts.
Because an ophthalmologist (not an optometrist) performs surgery for cataracts, Medicare covers the surgery under Medicare Part B. MMedicare covers fees from your ophthalmologist and the facility, but only the amounts approved by Medicare. You will pay a 20% Medicare Part B coinsurance for the surgery plus your Medicare deductible.
With cataract surgery, Original Medicare typically pays for standard intraocular lenses, but doesn’t usually cover upgraded lenses. If you want specialized lenses placed in your eyes, you’d probably be responsible for the additional cost.
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With cataracts, Medicare covers a pre-surgery exam to discuss your cataracts and anesthesia during the surgery. Medicare also covers any follow-up care. You'll pay the 20% Medicare coinsurance, plus any Medicare deductible before Medicare pays its share.
Medicare and eyeglasses for cataracts
Normally, Medicare does not cover routine vision correction, but Medicare does cover eyeglasses, contact lenses, and intraocular lenses following surgery to treat cataracts.
If you require eyeglasses, Medicare Part B only provides coverage for standard frames. For more expensive frames, you'll pay the difference over the amount approved by Medicare. Ask your doctor what frames are covered by Medicare.
Make sure your supplier is enrolled in Medicare and has a Medicare supplier number because Medicare won't pay your claim if your supplier doesn't have a Medicare supplier number.
You'll pay 20% of the amount approved by Medicare (your Medicare Part B coinsurance), plus your Medicare deductible. Remember to tell your doctor to send the bill for your eyeglasses or contact lenses to Medicare.
Call Medicare at 1-800-MEDICARE for more information on Medicare coverage of cataracts surgery and treatment.
Medicare has neither reviewed nor endorsed this information.